Outline

Objective: Spinal dural arteriovenous fistula (SDAVF) is a disease that is not efficiently diagnosed. Due to nonspecific and manifold clinical symptoms, there is a long delay between onset of first symptoms and definitive diagnosis. We report the case of a patient with progressive myelopathy believed to be caused by a large pelvic arteriovenous malformation which concealed a thoracic SDAVF.

Case illustration: A 62-year-old man presented with symptoms of progressive partial spinal paralyses. MRI showed edema of the thoracic cord and regional dilated perimedullary vessels. Repeated spinal angiograms failed to demonstrate a spinal d-AVF, however a large pelvic arteriovenous malformation was incidentally found. The pelvic AVM was repeatedly partially embolizes but failed to to yield any relief to the patient’s symptoms, the problems remained progressive. We performed a complete embolisation followed by AVM shunt disconnection. Thereafter his symptoms were regressive. Two months later the patients was readmitted because of renewed progressive symptoms. MRI showed a progressive congestive myelopathy. Pelvic angiogram showed no revascularization of the pelvic AVM. A spinal dural fistula was not detected by a renewed spinal angiogram. A multidetector computed tomographic angiography revealed a Th3 arteriovenous fistula. This was then clipped and the patient’s symptoms were regressive.

Conclusions: Spinal dural AVF is often misdiagnosed. In middle aged patients especially men with ascending motor or sensory deficits in the legs, spinal d-AVF should be considered. Multidetector computed tomographic angiography is a very useful diagnostic tool for its detection.